Healthcare Provider Details

I. General information

NPI: 1457624827
Provider Name (Legal Business Name): PERFORMANCE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 STATE ROUTE 15
LAFAYETTE NJ
07848-2607
US

IV. Provider business mailing address

156 ROUTE 15-NORTH
LAFAYETTE NJ
07848
US

V. Phone/Fax

Practice location:
  • Phone: 973-862-6377
  • Fax:
Mailing address:
  • Phone: 973-862-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAVINA DAURA
Title or Position: OCCUPATIONAL THERAPIST
Credential: MOT, MS, OTR/L
Phone: 973-862-6377